Autologous breast reconstruction after mastectomy (breast removal) involves recreating a natural-looking breast with the patient’s own tissue, usually from the abdomen.
Figure 1. Breast reconstruction with a DIEAP or SIEA flap (deep inferior epigastric artery perforator flap and superficial inferior epigastric artery flap) in combination with a lymph node transfer from the superficial groin area.
Breast cancer is the most frequent tumor among Spanish women, one in eleven will suffer from it. Mastectomy can be part of the treatment of breast cancer or be indicated preventively (genetic predisposition). In order to avoid sequelae, women can undergo different breast reconstruction techniques.
Breast reconstruction, types
There are many techniques but they can be classified into two main groups: those that use implants or prostheses and those that use autologous tissue: skin, fat and muscle of the patient.
Breast implants are a good option if the patient has not received local radiotherapy. The procedure is simple, short and does not require other incisions in addition to the mastectomy. To achieve a more natural result, refinement techniques such as fat grafting and acellular dermal matrices are used.
However, autologous breast reconstruction techniques (autologous tissue) offer the best results, since they manage to shape a breast similar to the one sacrificed in the mastectomy. Surplus” tissues from various locations such as the abdomen, back, thighs or buttocks are used.
Autologous reconstruction, procedure
Usually, the first option is to use tissue from the abdomen because it causes few sequelae and also achieves a benefit similar to that of an abdominoplasty. In addition, this breast reconstruction technique allows the transplantation of nodes from the groin to try to alleviate the lymphedema that many of these women suffer (after axillary lymphadenectomy associated with breast cancer treatment).
Nowadays, breast reconstruction makes it possible to recreate the breast taking into account the needs and desires of the patient. In this context, it is common to require small subsequent retouching interventions, simple and short processes to adjust the size and shape of the reconstructed breast. Finally, the symmetry of the breasts is pursued through the reconstruction of the nipple, the areola and lipomodeling (fat infiltration in certain locations).
The goal in Plastic Surgery is to ensure the best result with the lowest possible risk. To achieve this, it is essential to customize the different surgical techniques for each woman to agree on her wishes, with the reconstructive possibilities that her anatomy offers us.